The Medicare “death panels” bogeyman is back, reintroduced by, of all people, Rep. Paul Ryan,
the man who would reform the Medicare entitlement. What did Bill Clinton say about “brass”?

It was last month at the Republican Party’s happy hunting grounds known as The Villages, a
retirement community outside Orlando, Fla., that the vice-presidential hopeful told the assembled
crowd that Obama “puts a board of 15 unelected, unaccountable bureaucrats in charge of Medicare,
who are required to cut Medicare in ways that will lead to denied care for current seniors.”

Ryan is feeding fears over rationed care but fails to fess-up to the rationing he has in
store.

First, let’s sweep away misconceptions about the Independent Payment Advisory Board (note the
word
advisory), to which Ryan is referring. This is a key cost-containment provision of the
Affordable Care Act and a part of why the solvency of Medicare’s primary trust fund is eight years
longer under Obamacare than without it.

Here’s how the board works: Fifteen experts in health care, including consumers and seniors —
not government bureaucrats — appointed by the president but confirmed by the Senate, would be
charged with finding new efficiencies in Medicare’s medical delivery and payment system. If
increases in Medicare costs exceed a targeted amount — growth in the nominal gross domestic product
plus 1 percent after 2017 — the board must offer ways to rein those costs in. But the elected,
accountable Congress has the last word. It can adopt the recommendations or reject them as long as
it offers an alternative way to contain the rate of growth.

This studied approach preserves Medicare’s safety net features while forcing Congress to be
fiscally responsible, similar to the commission that helps close redundant military bases. It
should be applauded by Ryan, who claims to be a fiscal conservative.

Except no true fiscal conservative would vote to put two wars, tax cuts for the wealthy and the
Medicare prescription-drug benefit on America’s credit card, or help scuttle the bipartisan $4
trillion deficit reduction deal from the Simpson-Bowles commission, or propose a fiscal plan that
includes generous tax cuts to the rich and no balanced budget for at least another 28 years — all
of which Ryan has done.

So, while not a true fiscal conservative, he is opposed to government rationing care, right? Not
really.

Ryan’s budget blueprint, the one passed by the House in March, is a manifesto of
government-rationed care, a modern-day Magna Carta Libertatum to Ryan’s philosophy that freeing
Americans from debilitating government aid is the only way their productive potential will be fully
realized. Ryan introduced it by saying he doesn’t want America’s safety-net programs to become “a
hammock that lulls able-bodied people into lives of dependency and complacency, that drains them of
their will and their incentive to make the most of their lives.”

Ryan’s freedom agenda includes “vouchercare” through which Americans who become
Medicare-eligible in 10 years would have the freedom to hunt for private health insurance with a
rationed voucher that inevitably won’t keep up with medical inflation.

For middle-class seniors needing a nursing-home placement paid for by Medicaid, Ryan gives them
the freedom to cover the average $80,000 annual price tag or find some other living arrangement, by
transforming Medicaid’s open-ended guarantees into a rationed block grant to the states and cutting
funds 35 percent by 2022.

Poor families would have the freedom to either find jobs or go hungry, since their access to
food stamps would be rationed. Ryan would block grant that program, too, and institute a time
limit.

The man has taken as an injunction Janis Joplin’s famous lyric that “freedom’s just another word
for nothing left to lose.” Where FDR would grant us freedom from want, Ryan gives us freedom from
help. But at least there will be no “unaccountable bureaucrats” subverting Medicare; Ryan will have
already done that job for them.